PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
NEW ACTIVITY NARRATIVE:
SUMMARY
In the final year of the program, activities will continue to be carried out by the prime partner MYRADA and
its sub-grantees in four districts. The main program in the field is high risk rural prevention, care and support
(now adopted as the Link Worker Scheme by the National AIDS Control Organization). This link worker
program has several components addressing HIV/AIDS prevention, care and support, one of which is
Prevention of Mother-to-Child (PMTCT) activities. The PMTCT activities include motivating pregnant women
to seek HIV counseling and testing (CT), providing CT following up with HIV-positive pregnant women to
access PMTCT, linking the existing village health committees to the existing PMTCT centers; and training of
Community Resource Persons (CRPs) in PMTCT outreach services. Specific target populations for this
activity include pregnant women, women in Self Help Groups (SHGs), village health committees, and CRPs.
Expected program results are in line with the National AIDS Control Program Phase 3 (NACP-III) plans of
the National AIDS Control Organization (NACO), and will contribute to improving the current situation in
Karnataka state.
BACKGROUND
MYRADA, a 40 year old field-based NGO based in Karnataka, India, has been directly working in the focus
areas of improving livelihoods of poor and vulnerable women, natural resource management, reproductive
child health (RCH) and HIV/AIDS in the state of Karnataka, and neighboring border areas of Tamil Nadu
and Andhra Pradesh. In addition, MYRADA provides regular technical assistance to various government
and non-projects in India, Central and South Asia, and Africa. All MYRADA's work is built on the underlying
principles of sustainability and cost effectiveness through building local people's institutions and capacities,
and fostering effective linkages and networking. These principles have also been incorporated into the
MYRADA's program with USG since its inception in FY 2006.
In the first 2 years of this program (FY06), MYRADA decided to work in two districts of Northern Karnataka
- Belgaum and Gulbarga. This has now changed following a request by NACO, CDC and USAID that only
one agency support one district. The MYRADA program will now implement its activities in four districts that
have been allocated by the Karnataka State AIDS Prevention Society (KSAPS) to MYRADA.
ACTIVITIES AND EXPECTED RESULTS
One of the identified areas for implementation in the four districts was PMTCT. Until recently, the uptake of
PMTCT services in the state was around 10%. The new National Rural Health Mission (NRHM) in
Karnataka has strengthened the program by incorporating referral and follow-up of pregnant women
through the existing local health system of Auxiliary Nurse Midwives and Accredited Social Work Activities
workers. There is still, however, a need for individual follow up and counseling of HIV-positive pregnant
women.
In FY09, the PMTCT activity will be expanded to four districts in Karnataka (Chamrajnagar, Kodagu,
Mandya and Bidar), three of which are located in southern Karnataka. In all these areas, MYRADA already
has a presence in other development projects. This will enable the team to initiate this program relatively
quickly. New components of this activity will be initiated, including follow-up counseling of positive pregnant
women, as well as linkages with the Village Health Committee and government PMTCT centers. While the
government PMTCT centers will provide the actual PMTCT medical services and drugs, MYRADA will do
the community outreach, referrals and follow up. Care has been taken to ensure that the field areas are not
being covered under the USG-supported Samastha program in Karnataka to avoid any possible overlap
and double counting.
ACTIVITY 1: Community Outreach to All Pregnant Women to Avail PMTCT Services
Through a group of CRPs, all pregnant women in the selected areas of four districts will be motivated
through one on one and group discussions in their communities to undergo VCT, after which they will be
followed up if tested HIV positive. Their partners will also be motivated to support this. The CRPs will also
work with Self-Help Groups and the Village Health Committees (VHCs) to link the committees to the existing
PMTCT centers and to strengthen VHC support for CT testing for pregnant women and subsequent
attendance at PMTCT if the woman is HIV positive. VHC members and community level workers will be
trained in the basics of PMTCT.
By FY09, all pregnant women in 400 villages of 4 districts will be motivated to undergo HIV testing and at
least 50 % of those testing positive will be followed up on for 18 months after delivery. It is expected that
the percentage of pregnant women getting tested in all the four implementation areas will increase
significantly, and that the current average PMTCT uptake of around 20% will increase to at least 50%. This
will include both women who use the Myrada CT outreach services as well as those who are motivated to
use government CT and PMTCT services.
ACTIVITY 2: Provision of Counseling and Testing for Pregnant Women
The MYRADA outreach voluntary counseling and testing center (VCTC) will continue to do voluntary
counseling and testing (VCT) of all pregnant women. If found positive, follow up will include specific follow-
up counseling, ensuring that the women undergo regular antenatal health check ups and referring them for
institutional delivery at the PMTCT center and ART workup at the government ART center. These women
will be followed up on for 18 months after delivery, during which time the focus will be on infant feeding
practices, health of mother and baby and referring the baby for HIV testing at the age of 18 months.
ACTIVITY 3: Establishing Linkages between VHC and PMTCT Centers
One of the outcomes of the prevention programs with adult men and women has been the formation of
village health committees (VHCs), which are local institutions responsible for HIV and related health
activities in each village. One of the VHC responsibilities is to ensure that all pregnant women in their
villages make use of PMTCT services. The program staff will set up effective linkages between these
committees and the government PMTCT centers so that referral will be effectively implemented. All 100
VHCs formed will be linked to the nearest PMTCT center.
Activity Narrative: ACTIVITY 4: Adaptation and Translation of Training Material
Training material on communicating PMTCT messages with pregnant women, already developed by the
CDC-supported ITECH project, will be adapted and translated into Kannada and distributed to the
community level workers and village health committee members. This will ensure that standard and correct
messages are communicated in all areas.
ACTIVITY 5: Training of Outreach and Other Staff
In order for the activities to be carried out, all CRPs and their supervisors will be trained on the basics of
PMTCT. The CRPs will also be trained in follow-up counseling, while the VHC members will be trained on
the basics of PMTCT and the importance of linkages with the government.
ACTIVITY 6: Long-Term Sustainability
By the end of FY09, it is hoped that MYRADA will establish a good referral system in all its working areas
between the local village and the government PMTCT centers, whether through the VHC, Self-Help Groups
(SHG), or any other appropriate persons. This will continue through FY10. It will ensure sustainability of the
program and a strong link between the communities, the local-community based organizations and the
government. Using CRPs from the district positive network will facilitate their own programs in the field,
enhance their capacity to do outreach, provide livelihood options to PLHA, and address stigma and
discrimination issues in the field through their interactions with the community members and leaders. Active
collaboration with other PEPFAR-funded partners such as INP+ and IndiaCLEN will strengthen the overall
PMTCT response in the three southern high prevalence states of India.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $30,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
CONTINUING ACTIVITY - NEW ACTIVITY NARRATIVE
Youth interventions are one of the key focus areas of the third National AIDS Control Program (NACP-III)'s
plan for India. Continuing into the third year of the program, MYRADA will target youth, both in colleges and
in the community. The program will focus on abstinence, while certain high-risk youth will be addressed
separately through other program areas. The program also works with young couples and adults in rural
communities to focus on the importance of being faithful. Key target groups for these activities are
adolescents and young adults.
MYRADA, a 40-year-old field-based non-governmental organization (NGO) based in Bangalore, Karnataka,
India, has been directly working in the areas of empowering poor and vulnerable women, natural resource
management, reproductive child health (RCH) and HIV/AIDS in the state of Karnataka, and neighboring
border areas of Tamil Nadu and Andhra Pradesh. All MYRADA's work is built on the underlying principles of
sustainability and cost effectiveness through building local people's institutions and capacities, and fostering
effective linkages and networking. These principles have also been incorporated into the MYRADA USG
program.
In the first year of this program (FY06), MYRADA decided to work in two districts of Northern Karnataka -
Belgaum and Gulbarga. These are socio-economically backward districts with high HIV prevalence (over
3% in general population) that are located next to two other HIV high prevalence states, Maharashtra and
Andhra Pradesh. The initial strategy was to develop community-based models for sustainable HIV
prevention activities.
India's epidemic is not generalized. With a prevalence of 0.36% (NFHS and NACO 2007 reports), most of
the focus is on prevention. While all youth may not be sexually active, there is an urgent need to address
their understanding of vulnerabilities to risky behavior situations, more so in the case of young women. In
the UNDP-supported CHARCA project with young women implemented in Bellary, MYRADA learnt that
several factors such as early marriage, pre marital sexual abuse, lack of assertiveness skills, local sexual
cultural practices and a very low knowledge of the basics of HIV/AIDS transmission dynamics were
important issues related to increasing young women's risk to HIV/ AIDS. Young men also needed to
understand these vulnerabilities in order to develop positive attitudes towards women as well as reduce
their own risks. MYRADA decided to work with youth in college settings as a starting point, as it was easy to
access the youth on a repeated basis to reinforce prevention and life skills messages. In the second year,
the program also targeted out-of-school youth through community based programs.
Through USG's program with the Tamil Nadu State AIDS Control Society (TNSACS), MYRADA became
familiar with the Red Ribbon Clubs (RRCs) in colleges, and initiated the same concept in 4 taluks of
Belgaum and Gulbarga districts. This field program is currently implemented by two subpartners. There are
around 160 RRCs functioning, which are seen as local-level institutions that can respond to the needs of
peers within and outside the college setting. Each RRC consists of a group of student members who have
joined the club on a voluntary basis. They select a core group to manage the regular functions of the club,
two of whom are elected as RRC peer leaders. Some of the activities include regular monthly meetings,
interactive competitions (painting, quiz, debates, essays) on the themes of youth, vulnerabilities to HIV and
care and support; support to Orphans and Vulnerable Children and PLHAs, involvement in public functions,
contributing articles to the local press, and conducting awareness programs in local adopted communities.
Together with TNSACS and a resource organization called Insa India, MYRADA developed a two- part
curriculum for youth. The first part is a 3-hour curriculum addressing large groups of youth aimed at
stimulating their interest in understanding key issues related to adolescence, HIV and related vulnerabilities.
The second part is a 10 hour-curriculum that could either be administered as 10 one-hour capsules, or
covered in a two-day workshop. This is available to all interested youth and all RRC members. Special
faculty have been identified and trained to handle these sessions. In addition, several issues raised through
the suggestion boxes in all colleges are discussed every month in the RRC.
MYRADA will continue this activity in Belgaum and Gulbarga and expand to another 140 colleges in other
districts. Based on the experience of the first two years, special attention will be given to the high-risk youth
in colleges through one to one and group discussions. This activity has to be addressed tactfully in a state
that has banned sex education in schools and colleges.
ACTIVITY 1: Formation and Strengthening of New Red Ribbon Clubs
Around 160 red ribbon clubs have already been formed in the Belgaum and Gulbarga field areas. This year,
the whole district will be approached and an additional 40 clubs will be formed. One hundred new clubs will
also be formed in the expanded areas of Chitradurga, Chamrajnagar and Kolar districts, taking the overall
total to 300. All clubs will select two peer leaders who will get special training on peer education for HIV
prevention.
ACTIVITY 2: Life Skills Training for Youth in Colleges and Out-of-School Youth
Using the curriculum already developed for youth, all sub-grantees and field teams will organize and liaise
with the Red Ribbon Clubs to conduct regular life-skills training using both the three- hour primer and the 10
hour curriculum. A total of 25,000 youth will be covered in the project year through this curriculum. The field
teams in all rural working areas will also continue to conduct regular programs at the village level for out-of-
school youth using the same life skills training material, reaching around 15,000 out-of-school youth. The
issues of gender-based violence, cultural sexual practices, early marriage and pre marital sex will also be
addressed. All young persons getting ready to be married will be encouraged to be voluntarily tested for
HIV.
ACTIVITY 3: Training of Selected Youth Leaders
Activity Narrative: The selected RRC peer leaders will be trained on peer counseling, basic care and support issues, advocacy
for youth, reducing stigma and discrimination, and community mobilization. They will also be trained to
identify youth with high-risk behaviors and those youth experiencing sexual abuse, and link them to
counseling and the other program area dealing with condoms and other prevention. Around 500 peer youth
will be trained.
ACTIVITY 4: Mainstreaming Youth-Based Prevention Programs
With a view to sustainability, the program team will work with the Department of Education and universities
to mainstream the youth curriculum to all colleges. There will be deliberations with the National Social
Services (NSS) wing of the Ministry of Youth Affairs to leverage financial and administrative support for
mainstreaming this activity. A corresponding USG-supported project is being implemented by the
Karnataka Health Prevention Trust (KHPT) and MYRADA will collaborate with KHPT to incorporate the Life
Skills Curriculum into their project areas.
ACTIVITY 5: Providing Technical Support to KSACS
MYRADA is a highly respected organization in Karnataka and often uses its experiences, technical skills,
and reputation to build the capacity of others in the state. MYRADA staff will expand its technical support to
the Karnataka State AIDS Control Society (KSACS) in the areas of HIV prevention, gender issues, rural
outreach, community mobilization, and communication. A full time consultant placed in KSACS under the
guidance of both the KSACS project director and MYRADA will be hired in FY08 to provide KSACS with
much needed manpower and expertise. MYRADA staff will continue to be active members of a State
Advisory Panel for HIV communication strategies.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14290
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14290 11499.08 HHS/Centers for MYRADA 6766 3964.08 $75,000
Disease Control &
Prevention
11499 11499.07 HHS/Centers for MYRADA 5617 3964.07 $100,000
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
The changes are largely in the geographical area. Based on a request from NACO, CDC and USAID that
one agency support one district, MYRADA has agreed to withdraw from Belgaum and Gulbarga. The
districts finalized for the MYRADA USG program in consultation with KHPT and KSAPS are Chamrajnagar,
Bidar, Mandya and Kodagu. All activities planned in the FY08 COP will shift to these districts in FY09.
Since Year 1 of the USG program with MYRADA, these activities have been part of what was called the
"Rural Comprehensive Prevention and Care Model." The program has now been renamed the "Link Worker
Scheme" to reflect its similarity to the NACO link worker program.
MYRADA will implement this program in 3 phases:
Phase 1 (18 months): Initial selection of high-risk villages, preparing various groups in the community to
understand HIV and respond to prevention and care needs, and preparation of the local governance and
Village Health Committee (VHC) units to understand HIV and related health issues.
Phase 2 (1 year): Regular refresher training of the community, follow up of high risk groups and capacity
building of the local governance and VHC units to take over roles and responsibilities related to HIV,
reproductive and child health and other health issues.
Phase 3 (1 year): Handing over responsibilities to the community structures and mentoring them to carry out
prevention and care activities.
The link worker program activities encompass several program areas such as PMTCT, TB/HIV, abstinence
and being faithful, other sexual prevention, adult care and support and health system strengthening. It
covers the adult men, women, youth, pregnant women, high risk groups, PLHAs and OVCs in the village, as
well as the VHCs and gram panchayats. Each program area will outline its activities under the link worker
ACTIVITY 1: Training Women in Self Help Groups (SHG)
In India, the self-help group movement has been a great boon to women's empowerment. Started for
purposes of savings and credit management, these have become excellent forums to address women on
issues that impact their lives directly. During the year, all self-help groups in the new areas will undergo a
three module training using an interactive story through flip charts (Phase 1). Once trained, these women
will spread the message to their family and friends on sexual negotiation and communication, recognition of
STI symptoms, and HIV testing. Around 100,000 women in the three new districts will go through this
Phase 1 training in FY09. For those groups that have already undergone the training, there will be a
refresher training program.
ACTIVITY 2: Working with High-Risk Groups
Included in the intervention package in selected high-risk villages are specific interventions with high-risk
groups such as female sex workers, MSMs and devadasis. The community resource persons (CRPs) will
ensure that all those self identified will receive information on HIV and related issues, get an adequate
supply of condoms, and have a medical check up regularly to rule out STIs. All sex workers will be referred
for voluntary counseling and testing (VCT). Condom outlets will be established in every village.
ACTIVITY 3: Working with Men in Informal Groups and the Local Workplace
While women are easy to access in groups, the team will address men in informal groups and in their local
workplace settings. This activity was on demand by the community and will serve as a complementary
intervention to the women's SHG program as the program will be rolled out in the same areas to reinforce
messages to SHG women. The activities start with 3-4 hour focus group meetings followed by one to one
discussions and follow up sessions. At the workplace, the men will be addressed in consultation with
management staff. Perceived to be most at risk, these groups of adult men are difficult to find outside their
villages. This activity will continue as a series of informal discussions covering topics such as basic facts on
HIV and STIs, risk perception, prevention and testing services with adult men and will reach 400 villages in
FY09.
ACTIVITY 4: Strengthening the Village Community Structures and Local Governance Units
This is a key follow up activity that will be taken up in the areas where Phase 1 has been completed
(Belgaum and Gulbarga in early FY09, and Chamrajnagar at a later stage). Two hundred gram panchayat
(village governing body) areas will be covered. Each committee will undergo a standardized training and
then have regular monthly meetings. This activity will be linked with advocating for policies on the formation
of these sub committees with the Rural Development and Panchayat Raj Ministry.
ACTIVITY 5: Capacity Building of Outreach Staff Working with Most at Risk Populations
Regular field-based training programs will be conducted to train the CRPs and other NGO outreach workers
in the districts and neighboring areas in strategic community mobilization and outreach planning for FSWs
and MSMs. All these activities are well in line with the national program, and are among the key strategies
of NACP-III.
FY 2008 NARRATIVE
Many HIV/AIDS programs have focused on at-risk populations in urban areas, although women and men in
rural areas are also at risk. Specific groups targeted in this program include adult rural women in Self Help
Groups (some of who may be hidden sex workers), adult men (focus on migrants, unorganized work force),
"devadasi" women and known sex workers. While the level of risk varies in Karnataka, specific factors such
as migration, the devadasi system and hidden sex work in the rural areas are related to risk. The need for
messages on safer sex practices including correct and consistent condom use, reduction of multiple
partners, mutual monogamy is required in addition to "Be faithful" messages for these groups. Issues
Activity Narrative: related to sexuality and gender violence, need for counseling and testing, early detection and treatment of
STIs and consistent and correct condom use are also addressed in this area. This activity area is well in
line with and a key strategy of the third National AIDS Control Program (NACP-3). It also complements the
prevention programs of the Bill and Melinda Gates Foundation, which are limited to urban locations.
Myrada, a 40-year-old field-based non governmental organization (NGO) based in Bangalore, Karnataka,
border areas of Tamil Nadu and Andhra Pradesh. All Myrada's work is built on the underlying principles of
effective linkages and networking. These principles have been incorporated into the Myrada CDC program.
In the first year of this program (FY06), Myrada decided to work in two districts of Northern Karnataka:
Belgaum and Gulbarga. Several reasons led to this decision including the fact that these were districts with
high HIV prevalence (over 3% in general population); were socio-economically backward districts and
located adjacent to 2 other HIV high prevalence states, Maharashtra and Andhra Pradesh. The initial
strategy was to develop community based models for sustainable HIV prevention activities.
Based on experience in HIV prevention, Myrada realized that the strategy used in urban areas of designing
targeted interventions with commercial sex workers to reduce HIV transmission would be counterproductive
in rural areas. In the first place, most sex workers resident in the rural area only practiced sex work in the
nearby towns (an exception may be the devadasi community) and were not known in the village as sex
workers. (Devadasi is a system in which an unwanted young girl is "dedicated" to the Goddess Yellamma
by handing her over to an older adult male; while he provides for her, she is also "available" to other men
invited by him, her parents and the temple authorities. He may also pass her off to another person when he
no longer has any use of her. She sometimes ends up becoming a female sex worker (FSW). This practice
is particular to Belgaum, Bagalkot and a few northern Karnataka districts, and is now illegal). Identifying the
two-three "known" resident sex workers and targeting them in the rural areas would not only be cost-
intensive, but could lead to discrimination against her by the general community. Secondly, many rural
women suffer from sexually transmitted infections (STI) and the second largest group of HIV-positive
persons in India are monogamous rural housewives. The program therefore targets all sexually active
women and men to learn the dynamics of HIV transmission, and the importance of safer sex practices.
Myrada has focused on large well-organized populations of adults in high prevalence communities,
including women in self help groups and men in the local workplace. By FY07, around 85,000 persons had
been reached in the high-risk areas of Belgaum and Gulbarga. Myrada also increased outreach to men
outside the organized sector, and to local governance members (gram panchayats) through group
discussions and trainings.
Results from the initial programs show success in building local institutions. Women who have been trained
are now openly talking about issues related to sexuality and HIV within their neighborhood, actively seeking
counseling and testing, and demanding that condom outlets be placed in their villages. The training
modules for women include topics related to gender violence, sexual abuse, infidelity, alcoholism. The men,
both in workplace settings and in the community groups are very keen to learn more about HIV and where
to access treatment for STIs, and wanted condoms to be accessible close to their homes and workplaces.
The workplace managements were very supportive and in some cases sponsored STI health and
counseling and testing camps within their premises.
As a follow-up mechanism to this outreach program, Myrada identified the concept of the Village Health
Committees. This group of representative members from women's groups, gram panchayat, and the local
health department are selected by the general community to take up certain responsibilities in the village
including: organizing regular awareness programs, setting up and maintaining condom outlets, addressing
HIV facilitating co-factors such as alcohol abuse, and providing support and linkages to Most At Risk
Populations and PLHAs. Currently 140 village health committees have been formed.
ACTIVITY 1: Training Women in Self-Help Groups (SHG)
In India, the self help group movement has been a great boon to women's empowerment. Started for
purposes of savings and credit management, the groups have become excellent forums to address women
on issues that impact their lives directly. With FY08 funds, all self help groups in the new areas will undergo
a three-module training in HIV/AIDS outreach using an interactive story through flip charts. Once trained,
these women will spread the message to their family and close friends. Around 100,000 women in the new
districts of Chitradurga and Chamrajnagar will go through this Phase 1 training in FY08.
ACTIVITY 2: Formation and Strengthening of Sub Health Committees (Phase 2)
This follow-up activity will take place in the areas where Phase 1 has been completed (Belgaum and
Gulbarga). Two hundred gram panchayat areas will be covered. Each Sub Health Committee will undergo
a standard training and have regular monthly meetings. The activity will be linked with the activity with the
Rural Development and Panchayat Raj ministry to influence policy decisions for the formation of these sub
committees (see the Policy and Systems Strengthening narrative)
ACTIVITY 3: Reaching Men in the Organized and Unorganized Sectors
Existing HIV/AIDS prevention programs in the workplace will continue. Myrada will focus on getting
managements to develop a workplace policy, thereby integrating HIV/AIDS prevention and care into their
personnel policies. The workplace programs, together with supportive programs such as STI health camps,
VCT camps and condom promotion, will reach around 20,000 adult men.
Men in the unorganized sector, who are perceived to be most at risk, are difficult to reach on a regular basis
Activity Narrative: outside their villages. Many migrate to other areas in search of work. Myrada will use an "origin and
destination" approach to reach this vulnerable population. To reach these adult men in their villages,
Myrada will support a series of ongoing group discussions covering topics such as basic facts on HIV and
STIs, risk perception, and prevention and testing services. 400 villages will be reached in FY08. In addition,
regular field-based training programs will be conducted to train outreach workers from Myrada's sub-
partners and staff from selected NGOs working in neighboring Goa (a large number of MARPs migrate from
northern Karnataka into Goa) in strategic community mobilization and outreach planning for vulnerable
populations, FSW, and men who have sex with men.
ACTIVITY 4: Technical Support to Karnataka State AIDS Prevention Society (KSAPS)
Myrada is a highly respected organization in Karnataka and often uses its experiences, technical skills, and
reputation to build the capacity of others in the state. Myrada staff will expand its technical support to
KSAPS in the areas of HIV prevention, gender issues, rural outreach, community mobilization, and
communication. A full-time consultant placed in KSAPS under the guidance of both the KSAPS project
director and Myrada will be hired in FY08 to provide KSAPS with much needed manpower and expertise in
these areas. Myrada staff will continue to be active members of a state advisory panel for HIV
communication strategies.
Continuing Activity: 14291
14291 11500.08 HHS/Centers for MYRADA 6766 3964.08 $105,000
11500 11500.07 HHS/Centers for MYRADA 5617 3964.07 $40,000
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $70,000
Table 3.3.03:
The geographical area has changed. Based on a request from NACO that one agency support one district,
MYRADA agreed to withdraw from Belgaum and Gulbarga. The four districts that MYRADA will now target
are Chamrajnagar, Bidar, Mandya and Kodagu. All activities planned in the FY08 COP will shift to these
districts. The activities are part of NACO's Link Worker Scheme (see the "Other Sexual Prevention"
narrative for details). In addition, the program will work with district, state and national level positive
networks to improve the quality of adult care and support programs through a sub-partner that is yet to be
decided (potentially INP+).
ACTIVITY 1: Basic Community-Based Palliative Care
This will be implemented through the Link Worker Scheme by a team of PLHA community resource persons
(CRPs) in the four selected districts. The CRPs will identify and register PLHA into the program. Regular
palliative care will include: regular medical check up, home-based care, family counseling, Positive
Prevention/follow-up counseling, nutrition support, referral for OI management, CD4 testing and ART work
up, ART follow up, and linkages to livelihood and other social schemes. In FY09, it is expected that around
400 persons will receive palliative care.
ACTIVITY 2: Training of Caregivers and Community Volunteers on Home Based Care
Around 100 persons from the four districts will be trained in the basics of home-based care and nutrition
supplementation. Both male and female caregivers will be trained.
ACTIVITY 3: Sensitization of Community Leaders to Reduce Stigma and Discrimination
With the existing stigma, it is difficult for PLHA to disclose their status. Unless the community and the health
-care system are willing to accept their status, PLHAs will not come forward to access services. In all 400
villages, orientation programs will be held with community leaders regarding stigma and discrimination.
ACTIVITY 4: Translation and Training of Positive Prevention/Follow-up Counseling Toolkit
Counselors and Peer Educators are often the first point of contact with the health-care system and play a
pivotal role in linking PLHA to critical care and support services. MYRADA plans to conduct training in the
four districts on using the Prevention with Positives Follow-up Counseling Toolkit, prepared by the Indian
Clinical Epidemiology Network with USG financial and technical support. The toolkit has a standardized
curriculum (prepared with USG support to ITECH in FY08) that covers advanced issues of living with
HIV/AIDS, including stigma and discrimination, disclosure, safer sex, care, prevention, and mental health
issues. Training lasts 3-5 days and focuses on providing skills and tools to counselors on issues specific to
PLHA. The modules will be translated into Kannada. MYRADA will encourage KSAPS and other agencies
to include these modules as part of their care and support package of services.
ACTIVITY 5: Capacity Building of District Network Staff
Special training programs will be held for staff of the district positive networks on palliative care
programming, and how to plan and manage such a program. This will include training on Positive
Prevention/Follow-up Counseling using the toolkit.
The following activities, previously funded by USG through direct funding to INP+, will be undertaken by
MYRADA through a sub-partner (potentially INP+).
ACTIVITY 6: Strengthening the INP+ Family Counseling Centers (FCC) at the Government Hospital for
Thoracic Medicine (GHTM), Chennai and Government Chest Hospital, Hyderabad
INP+ started its first FCC in 2004 to provide on-going psychosocial counseling to PLHA visiting GHTM - the
largest HIV Care Center in India. Symbolically, this has helped PLHA and INP+ advocate for a more holistic
approach to care and treatment and more specialized PLHA support since GHTM is seen as a model
government HIV care center.
The INP+ counselors at GHTM provide partner counseling, individual bedside counseling and group
counseling on various issues facing PLHA. Special effort is placed on Prevention for Positives messages.
This activity has helped PLHA in areas such as reducing stigma and discrimination, exercising women's
legal rights as widows and availing inheritance for children. Group counseling on self-care, home care,
nutrition and positive living is part of the process. INP+ started a similar facility in Hyderabad attached to the
Government Chest Hospital in Andhra Pradesh (AP). About 30,000 PLHA and their family members will be
reached through this activity.
MYRADA, in partnership with a positive network (potentially INP+), will further streamline the processes and
strengthen FCC services. It will also provide TA on documenting the process and effectiveness of the
counseling tool kit.
ACTIVITY 7: Strengthening the Life Focus Center (LFC) (Drop-in Center) at GHTM
The LFC began in 2004 as an extension of the FCC at GHTM. This drop-in center provides psychosocial
support, one-on-one peer counseling, and training for PLHA on topics such as income generation
(economic strengthening) and nutrition (food security). The center has a library, a computer and a place for
relaxation for PLHA coming from far to access services at the hospital. The center encourages PLHA to
obtain accurate information and connects them to district PLHA networks and service providers. More than
5,000 PLHA will be reached through this center with FY09 funds. MYRADA will work closely with the
positive network to strengthen the LFC concept.
ACTIVITY 8: Positive Speakers Program
MYRADA, in partnership with a positive network (potentially INP+), will train about 100 PLHA in the states of
Karnataka, Tamil Nadu and AP using the Positive Speaker Program which focuses on general prevention
and positive prevention messages to PLHA. The trained PLHA speakers will develop a state and district
plan for active involvement in prevention and stigma reduction activities in their communities. They will also
advocate for increased gender equity and will address legal rights of PLHA.
Activity Narrative: ACTIVITY 9: Strengthening District Level Networks (DLNs)
The core of INP+ structure and support comes from district and state level networks of positive people.
MYRADA will focus on strengthening these organizational units as both advocacy and service units. DLNs
receive support from the Global Fund to provide ART support services, hire outreach workers to track ART
defaulters, assist positive pregnant women with safe delivery and treatment, and establish drop-in
counseling and support centers. DLNs are also tasked to provide effective linkages between PLHA and care
providers, including services for TB treatment.
MYRADA will focus on strategies to strengthen these services managed by DLNs (as an example of
leveraging). Training in human resource management, monitoring and evaluation, HIV care and treatment
packages, and ART operational guidelines will be organized jointly by MYRADA and a positive network.
This program area will continue to address palliative care from a community perspective: that is, what the
community can provide and access, and how to link with existing services for long term sustainability. The
focus will be on training, providing nutrition support and encouraging the community leaders to respond
proactively to care and support of their positive community members. All identified PLHAs the targeted
areas of Belgaum and Gulbarga districts will be followed up. This includes community-level follow-up for 18
months after delivery of mother-baby pairs to support the PMTCT services provided by the Government of
India (GOI).
Myrada, a 40 year old field based non governmental organization (NGO) based in Bangalore, India, has
been directly working in the focus areas of empowering poor and vulnerable women, natural resource
effective linkages and networking. These principles have also been incorporated into the Myrada CDC
Palliative care involves all aspects of care and support of People Living with HIV/AIDS (PLHA) outside of
ART or TB medication. Several facets of palliative care have however been neglected due to a combination
of factors. While health care providers tend to equate care to medical treatment, PLHA have no clear idea of
the other components of care, and therefore cannot demand these services. In addition, most district PLHA
networks focus on advocacy issues and the importance of "positive speaking". Very few have been
convinced that they need to look after their own as much or even more than focusing on advocacy issues.
They have typically expected others to "provide" them the services.
Myrada initiated the palliative care program due to the felt needs of PLHA in Myrada's focus areas. While
some PLHA were affiliated to the district positive network, none of them were aware that there were
components of care besides ART. So far around 205 PLHA have been identified in the working areas of
Belgaum and Gulbarga. All of them are followed up on a monthly basis and receive regular counseling,
home based care, nutrition advice and referrals for medical check up and ART work up. Those who are on
ART are followed up in the field.
This year there will be a focus on ensuring that women get equal access to care and support services. The
local Self Help Groups will be encouraged to support their PLHA members through livelihood options, food
security, ensuring education of their children and the like. Village sub health committees (representative
members from women's groups, gram panchayat, and the local health department who are selected by the
general community to take up certain responsibilities in the village) will also propagate zero tolerance
messages towards discrimination and violence against infected women, handle property rights issues and
other HIV-related issues.
This program is being implemented in collaboration with the local district positive networks. This will
continue until Myrada is confident that these PLHA clients can be transferred to the USAID- supported
Samastha project.
ACTIVITY 1: Provision and Training in Basic Community-Based Palliative Care
This will be implemented through the district PLHA network by a team of PLHA community resource
persons (CRPs). These CRPs will identify and register all PLHA into the program. Regular palliative care
will include the following elements: regular medical check up, home based care, family counseling, nutrition
support, referral for opportunistic infection (OI) management, CD4 testing and ART work up, ART follow up,
and linkages to livelihoods and other social schemes. In the project year, it is expected that around 200
persons in Belgaum, Chitradurga and Kolar districts will be receiving palliative care. In the other two
districts, PLHA will be linked to the USAID-supported Samastha project care program. Around 100
persons, both male and female caregivers, will be trained in the basics of home-based care and nutritional
supplementation.
ACTIVITY 2: Follow-up and Care Post-Delivery
While the GOI PMTCT Centers will provide PMTCT services and drugs, Myrada will provide referrals and
Activity Narrative: will follow-up mother-baby pairs at the community level for 18 months after delivery. Community resource
persons trained by Myrada will conduct follow-up visits, focusing on infant feeding practices, the health of
the mother and baby, and referring the baby for HIV testing at 18 months. It is expected that at least 30% of
those pregnant women tested positive under Myrada's CT intervention will be followed up for the 18 month
period.
In all 400 villages, sensitization programs will be held with community leaders regarding stigma and
discrimination. This is an important component of palliative care. With the existing stigma, it is difficult for
PLHA to be "open" about their status. Unless they are willing to accept their status, they do not come
forward to access any other services. Community leaders can play an important role in influencing access
to services, community norms and the attitudes of health providers.
ACTIVITY 4: Translation and Adaptation of Follow-up Counseling Toolkit
This newly developed toolkit consisting of flip books and trigger videos has had a positive impact in getting
PLHAs to understand issues related to acceptance, need for regular care and support, stigma and
discrimination, and the importance of healthy positive living. The modules will be translated into Kannada
and used in care and support settings. Myrada will encourage KSAPS and other agencies to include these
modules as part of their care and support package of services.
ACTIVITY 5: Capacity Building of PLHA District Network Staff
Special training programs will be held for the staff of the district positive networks on palliative care
programming, and how to plan and manage such a program in their network area. Included in the package
will be trainings on follow-up counseling using the USG-developed toolkit.
ACTIVITY 6: Building Linkages with Other Program Activities and Service Providers
The community based care program is implemented in the same areas where the prevention outreach and
outreach counseling and testing programs are being implemented. Active linkages are already present in
the field area in Belgaum and Gulbarga using the CRPs and the newly established village health
committees that focus on HIV/AIDS. These mechanisms will be used to identify clients and strengthen
linkages among clients and services. .
Both the palliative care program area and OVC area will be managed by the district PLHA network with
extensive support from the Myrada team. It is hope that this support will enable them to strengthen their
capacities to sustain the services to their members over time. All medical services will continue to be
provided through the government program.
Continuing Activity: 14292
14292 6207.08 HHS/Centers for MYRADA 6766 3964.08 $20,000
10889 6207.07 HHS/Centers for MYRADA 5617 3964.07 $100,000
6207 6207.06 HHS/Centers for MYRADA 3964 3964.06 $150,000
* TB
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.08:
TB/HIV co-infection is the most common form of opportunistic infection seen in India. The National AIDS
Control Plan - Phase III (NACP-III) encourages TB/HIV cross referrals and follow up. Both the National
AIDS Control Program (NACO) and the Revised National TB Control Program (RNTCP) have made it
mandatory for all those detected as sputum AFB positive to get a HIV test referral, and vice versa. NGOs
are actively involved in identifying, referring and following up cases. The actual testing occurs in
government facilities.
MYRADA, a 40-year-old field-based NGO based in Bangalore, Karnataka, India, has been working directly
in the areas of empowering poor and vulnerable women, natural resource management, reproductive child
health (RCH) and HIV/AIDS in the state of Karnataka, and neighboring border areas of Tamil Nadu and
Andhra Pradesh. All MYRADA's work is built on the underlying principles of sustainability and cost
effectiveness through building local people's institutions and capacities, and fostering effective linkages and
networking. These principles have also been incorporated into the MYRADA USG program.
Belgaum and Gulbarga. However, after a special request from NACO for one district to be supported by
one agency, MYRADA will withdraw from Belgaum and Gulbarga and focus on Chamrajnagar, Mandya,
Bidar and Kodagu districts.
In the earlier years, the program did not actively work in the TB/HIV program area, although there were
referrals for testing. In FY09, as a result of the Link Worker Scheme model (an adaptation of Myrada's
FY07-08 Rural Prevention Program) now being endorsed by NACO, referral and follow up of TB/HIV co-
infected cases will now be included in the MYRADA program. MYRADA plans to work closely with the
positive networks at national, state and district level and this will include some TB/HIV co-infection activities.
Activity 1: Referral of "TB Suspect" Cases for Sputum Testing
This will be done through the link worker program in select high-risk villages of the four districts
(Chamrajnagar, Kodagu, Bidar and Mandya) and through the positive network programs in Tamil Nadu and
Andhra Pradesh. The field teams of counselors and community resource persons (CRPs) will actively refer
all persons who are "suspect TB cases" (cough with sputum for three weeks or more with or without
hemoptysis, evening rise in fever, night sweats) to the nearest sputum testing center of the government.
Activity 2: Referral and Follow-Up of All HIV Positive Cases for Sputum Testing and Sputum AFB Positive
Cases for HIV Testing
Similarly, all PLHAs identified in the selected villages and in the working area of the positive networks will
be referred and followed up to have a sputum AFB test. In all areas this test will be conducted by the
government-designated microscopy centers. CRPs will also refer all confirmed TB cases for HIV testing.
The HIV testing will be done either at the government ICTCs or by Myrada's program outreach VCT teams.
All those found to be diagnosed with TB will be followed up actively, including referral to DOTS. All those co
-infected with HIV will be followed up in the adult care and support program component.
A total of around 400 PLHA will be actively followed up. All of them will be referred for sputum testing.
Around 50-75 TB positive cases will be followed up and started on DOTS.
Activity 3: Training of Field Staff on TB/HIV Basics
All the CRPs and counselors of the positive networks will be trained on the basics of TB/HIV co-infection.
Estimated amount of funding that is planned for Human Capacity Development $15,000
Table 3.3.12:
MYRADA has agreed to withdraw from Belgaum and Gulbarga. The districts finalized for the MYRADA USG
-supported program in consultation with the Karnataka Health Promotion Trust and the Karanataka State
AIDS Prevention Society are Chamrajnagar, Bidar, Mandya and Kodagu. All activities planned in the FY08
COP will now be shifted to these districts.
Published estimates of the number of HIV-infected children in India vary from 50,000 to 300,000 and there
may be 2-10 million children in India with an HIV-positive parent. The National AIDS Control Program has
only recently taken cognizance of children as People Living with HIV/AIDS (PLHAs) and, in collaboration
with international agencies such as the Clinton Foundation, infected children are now getting pediatric ART.
However, other aspects of care and support for OVC, such as nutrition, education and counseling have not
been systematically addressed by either the HIV-positive networks or the government. This intervention will
address comprehensive care and support for OVCs through a community-based approach. This is not a
stand-alone activity and is a natural follow up to the prevention outreach program.
border areas of Tamil Nadu and Andhra Pradesh. In addition, Myrada provides regular technical assistance
to various government and non government projects in India, Central and South Asia, and Africa. All
Myrada's work is built on the underlying principles of sustainability and cost effectiveness through building
local people's institutions and capacities, and fostering effective linkages and networking. These principles
have also been incorporated into the Myrada CDC program.
In the first year of this program (FY 2006), Myrada decided to work in two districts of Northern Karnataka:
Belgaum and Gulbarga. Several reasons led to these decisions including the fact that these were districts
with high HIV prevalence (over 3% in general population); were socio-economically backward districts and
located adjacent to two other HIV high-prevalence states, Maharashtra and Andhra Pradesh. The initial
strategy was to develop community-based models for sustainable HIV prevention activities.
The past two years have taught us that focusing only on prevention in high prevalence districts is not
enough. In the course of the program, several OVCs were identified. Since there were no interventions in
place, Myrada initiated a community-based OVC program in Belgaum and Gulbarga, working with the
district-level positive networks as sub grantees. The six components of primary care mandated by WHO
and the Government of India (GOI) for OVC have been introduced, including testing for HIV, CD4 testing for
those found HIV positive, regular medical check ups, referrals for minor illnesses, nutrition support, support
for education and family counseling. In addition, the teams have been working with the village health
committees and other leaders to advocate for a reduction in stigma and discrimination towards these
children and their families. Special focus has been on ensuring that both boys and girls get equal access to
care and support. The children are identified through the community based palliative care program and the
voluntary counseling and testing program.
Now that USAID is working in Karnataka with care and support as a major focus area, Myrada will explore
the possibility of transferring the 970 identified OVCs to the USAID program. Until then, the program will
continue services for this group of children.
ACTIVITY 1: Basic Care and Support for Registered OVCs
All identified orphans/vulnerable children of PLHA families will be registered with the Myrada program, and
encouraged to undergo HIV testing to determine their individual status. All registered OVCs will receive the
WHO/GOI six components of care regularly. OBC are also tracked for all six OGAC categories of OVC
services, with Myrada directly providing four of the six OGAC components. It is expected that around 300
OVCs in the implementation area will receive the total package of community-based care and support. The
others will receive certain components and will be linked to the USAID-supported Samastha project by
FY08 for the total package.
ACTIVITY 2: Regular Referrals for CD4 Testing and OI Management
All registered children will be sent for CD4 screening to determine whether or not they require ART. Those
found eligible will be referred to the pediatric ART centre. A few doctors trained to provide OI care will be
identified to provide regular medical check ups and treatment of OIs for these children. All these children will
also be followed up to see that they receive routine immunizations and vitamin supplements.
ACTIVITY 3: Families Livelihood Options and Social Entitlements
Many families are already socio-economically vulnerable following the illness/death of an adult member. It is
important to address this issue to help families identify their needs so that the remaining family members
can cope with their debt issues and future expenses. Women in the families will be linked to existing self
help groups, while all efforts will be made to link family members to available social entitlement schemes of
the government.
ACTIVITY 4: Training Family Care Givers
At least one adult family member will be specifically trained on how to manage the child at home, and how
to make a balanced diet plan for their children. This will include how to provide home-based care and
Activity Narrative: nutritious foods, as well as to know when to refer for medical care.
Continuing Activity: 16417
16417 16417.08 HHS/Centers for MYRADA 6766 3964.08 $10,000
Estimated amount of funding that is planned for Human Capacity Development $5,000
Table 3.3.13:
MYRADA has agreed to withdraw from Belgaum and Gulbarga. The districts finalized for the MYRADA
program in consultation with the Karnataka Health Promotion Trust and the Karnataka State AIDS
Prevention Society are Chamrajnagar, Bidar, Mandya and Kodagu. All activities planned in the FY08 COP
will shift to these districts.
The purpose of this activity is to make counseling and testing (CT) easily accessible to the rural remote
communities. Started in June 2006, this activity will continue in Belgaum and Gulbarga districts and expand
to 3 other areas in Chamrajnagar, Chitradurga and Kolar districts. The activity sends outreach CT teams to
remote rural government primary health centers to conduct CT of at-risk community members, including
Most at Risk Populations (MARPs), Sexually Transmitted Infections (STI) patients, TB patients, and
pregnant women. In FY08 there will be a strong emphasis on motivating pregnant women to access CT,
links with PMTCT Centers and follow-up after delivery.
Myrada, a 40 year old field based non governmental organization (NGO) based in Bangalore, Karnataka,
India, has been directly working in the focus areas of empowering poor and vulnerable women, natural
resource management, reproductive child health (RCH) and HIV/AIDS in the state of Karnataka, and
neighboring border areas of Tamil Nadu and Andhra Pradesh. All Myrada's work is built on the underlying
and fostering effective linkages and networking. These principles have been incorporated into the Myrada
CDC program.
When this program was initiated in June 2006, only 30% of around 75 Government of India (GOI)
Counseling and Testing Centers (CTCs) were functional. Therefore Myrada used two approaches: a static
clinic-based CTC and outreach CT through sub-grantee partners in two high HIV- prevalence districts of
northern Karnataka: Belgaum and Gulbarga. Demand for testing is generated during the outreach
prevention programs in the neighboring rural communities and workplace sites. The outreach CT team
consists of a counselor and lab technician who travel by local public transport to a remote government
primary health centre (PHC) on a fixed schedule twice a month. A HIV-positive person was included in the
team as a peer counselor. His/ her role is to assist in post-test follow-up counseling and offer peer-based
counseling options. From last year's experience, this model has strengthened the link to care and support
for those who were detected positive. The teams also respond to invitations to conduct programs at
workplaces and large villages where the local governance teams (gram panchayats) provide space and the
local communities organize the people.
The outreach CT teams have been well received in the PHCs. Over 9000 persons were tested and
received their test results in a span of 9 months. Out of the 9,000 tested, the positive rate has been around
3.9%. Each team has tested around 2,000 persons. The approach is cost effective since it is integrated into
the GOI's PHC system, and is replicable and sustainable. The average cost per team is around $4,500 per
year (excluding the costs of the first-line testing kits). Testing kits have been and will continue to be
leveraged from Karnataka State AIDS Prevention Society (KSAPS).
Another interesting feature is that the majority tested were rural women (68%). This is an encouraging
statistic for health-seeking behavior and gender equity and may be the result of the intensive sexual health
interventions for self-help group women conducted by Myrada in these communities.
ACTIVITY 1: Counseling and Testing through Mobile Teams
In FY08, since KSAPS has recently expanded their testing centers to over 500 across the state, Myrada will
end the static CT model. Using seven mobile teams, outreach CT will continue in Belgaum, Gulbarga, and
expand to Chamrajnagar, Kolar and Chitradurga districts. Counseling and testing will follow NACO
guidelines. It is planned to reach 10,000 at-risk persons in remote government PHCs, workplace sites, and
community hot spots (the purpose of supporting testing at the PHCs is the goal of mainstreaming CT into
the regular functions of the PHC, for sustainability). Clients for the mobile CT will include adult men and
women from high risk villages, patients referred at the PHC, persons with TB, families of identified PLHAs,
and those referred by local health practitioners.
ACTIVITY 2: Community Outreach to Pregnant Women and Demand Creation for CT Services
Myrada will train community resources persons (CRPs) in the five target districts to expand their outreach to
pregnant women to motivate them to access CT services. Approaches will included one-to-one and groups
discussions in their communities. The CRPs will also work with Self-Help Groups and the Village Health
Committees (VHCs) to link the committees to the existing PMTCT centers and to strengthen VHC support
for CT testing for pregnant women and subsequent attendance at PMTCT if the woman is HIV positive.
VHC members and community level workers will be trained in the basics of PMTCT. It is expected that
through this activity and that the current average PMTCT uptake of around 4% in these areas will increase
to at least 50% if not more. By FY2008, the goal is that all pregnant women in 700 villages of 5 districts will
Activity Narrative: be motivated to undergo HIV testing and at least 50 % of those tested postive will be followed up till 18
months after delivery.
ACTIVITY 3: Linking Positive Persons to Care and Support
All those identified as positive by the CT team will receive follow-up counseling and be linked to care and
support services available in the district. These include basic opportunistic infection management, nutrition
support, counseling services and referral to ART centers for CD4 testing and HIV staging. In the Belgaum,
Chitradurga and Kolar areas, community based palliative care (details in the Palliative Care narrative) will
be provided through community resource persons (CRP), while in the other two districts, the teams will link
with the USAID-supported Integrated Positive Prevention and Care Centers (IPPCC) set up in these
districts.
people living with HIV/AIDS to understand issues related to acceptance, need for regular care and support,
stigma and discrimination, and the importance of healthy positive living. The modules will be translated into
Kannada and used by the program CT teams. Myrada will encourage KSAPS and other agencies to include
these modules as part of their counseling services
ACTIVITY 5: Training of Counselors and Technicians
By the end of FY08, all counselors and technicians will have undergone refresher training in CT skills, as
well as training in follow up counseling. Myrada, in collaboration with district health authorities, will also
train existing technicians and outreach staff in the PHCs visited by the outreach team in CT, so PHCs can
take on this function routinely.
ACTIVITY 6: Expanding the Outreach Testing Model
Under the National AIDS Control Program Phase 3 (NACP-3), mobile testing in high risk and remote
communities will be promoted and scaled up by State AIDS Control Societies with funding from NACO.
First, cost-efficient Indian models for mobile testing need to be piloted and documented. Myrada will
document the processes, cost effectiveness and experiences of the outreach testing module and share it
with other partners in the State, including KSAPS, as a basis for scaling up this approach. This model will
also be used in Gulbarga and Bellary districts under the USAID-supported Samastha project to which
Myrada is a sub partner.
Continuing Activity: 14293
14293 6206.08 HHS/Centers for MYRADA 6766 3964.08 $100,000
10888 6206.07 HHS/Centers for MYRADA 5617 3964.07 $100,000
6206 6206.06 HHS/Centers for MYRADA 3964 3964.06 $54,000
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.14:
In the final year of the MYRADA program, activities will continue to be carried out by the prime partner
MYRADA and its sub grantees in four districts. The program focuses on delivery of HIV/AIDS prevention,
care and support services to high-risk rural communities (now recognized by the National AIDS Control
Organization (NACO) in its Link Worker Scheme). This link worker program has several components,
including PMTCT activities, prevention with adults, youth and high-risk groups and primary level care and
support. All these activities require strong monitoring and supervision. Complex qualitative data is
collected while implementing the program which has to be analyzed to guide the program effectively.
In addition, MYRADA will be working closely with a positive network (potentially the Indian Network of
Positive People [INP+] whose District Documentation and Reporting Program in Andhra Pradesh is
complementary to the District AIDS Prevention and Control Unit (DAPCU) system for district and state
monitoring services in the state. MYRADA will also focus on strengthening PLHA skills in understanding
and using data for planning and advocacy.
MYRADA, a 40 year old NGO based in Karnataka, India, has been working directly in the focus areas of
improving livelihoods of poor and vulnerable women, natural resource management, reproductive and child
Andhra Pradesh. In addition, MYRADA provides regular technical assistance to various government and
non-government projects in India, Central and South Asia, and Africa. All MYRADA's work is built on the
underlying principles of sustainability and cost effectiveness through building local people's institutions and
capacities, and fostering effective linkages and networking. These principles have also been incorporated
into the MYRADA USG-supported program since its inception in FY06.
In the first two years of the USG program, MYRADA decided to work in two districts of Northern Karnataka
- Belgaum and Gulbarga. Recently, that geographical area has changed. Based on a request from NACO
that one agency support one district, MYRADA has agreed to withdraw from Belgaum and Gulbarga. The
four districts finalized for the MYRADA USG program, agreed in consultation with the Karnataka Health
Promotion Trust and the Karnataka State AIDS Prevention Society (KSAPS), are Chamrajnagar, Bidar,
Mandya and Kodagu. All activities planned in the FY08 will shift to these districts. MYRADA will also work
closely through a positive network and provide technical and strategic support for the organization.
The activities mentioned below were previously integrated into other program areas. Starting with the FY09
COP, they will be listed separately under the Strategic Information program area.
ACTIVITY 1: Strengthening Field-Based Monitoring Systems in Program Districts for All Program
Components
Although a field-based monitoring system is already in place, MYRADA will strengthen this systems to align
with all PEPFAR requirements. These include the village diary kept by the Community Resources Persons
(CPRs), supervisors' checklists and forms, monthly formats, and other reporting procedures. The central
team will review each reporting mechanism thoroughly to weed out information that is not utilized and thus
allow the program staff to invest more time in field activities. Feedback based on this review will be given to
staff for improved programming.
ACTIVITY 2: Conducting Regular Monitoring Reviews of Programs and Staff Performances in All Program
Districts
The central MYRADA team visits the field regularly and a general review is carried out quarterly at both the
field level and the central office. These reviews help to identify gaps in knowledge and implementation and
focus on key areas for improvement. Quarterly reports are generated from the field reports and submitted
to the USG office.
ACTIVITY 3: Train Staff in Data Collection and Management
All coordinators and supervisory staff in the four districts will undergo training to understand the importance
of data collection and analysis, and using the data for planning. A standardized curriculum will be prepared
in line with the data collection and monitoring systems of NACO.
ACTIVITY 4: Train Staff on Using Data for Decision Making
Besides the MYRADA teams, a special officer will assist the government District AIDS Prevention and
Control Units in all four districts to analyze and use their data for decision making. USG will provide
significant technical assistance for this activity.
ACTIVITY 5: Use of a Computerized Management Information System (MIS)
MYRADA has developed software to capture and analyze data for high risk group interventions managed by
the community itself. MYRADA will work with high-risk group community-based organizations (such as sex
worker organizations and PLHA) to set up program-monitoring MIS systems in their institutions. This
activity will cut across the state and other neighboring states.
ACTIVITY 6: District Documentation and Reporting Program
This activity complements the data gathering mechanism of the Andhra Pradesh State AIDS Control
Program. The Andhra Pradesh (AP) state-level PLHA network (TLN+), with the support of the AP District
Level Networks and technical guidance from INP+ and USG, started a District Documentation and
Reporting Program in July 2007. In this activity, a District Reporting Associate (DRA), who is a qualified
(high-school pass) PLHA assists the District Program Manager of a DAPCU. The DRA makes systematic
visits to hospitals, NGOs and other service delivery outlets, meets PLHA, collects data on services provided
to PLHA (besides ART), identifies the issues and gaps in service delivery, and passes this information to
the respective DPM and the District Monitoring and Evaluation (M&E) Officer. This activity has
Activity Narrative: strengthened advocacy with the AP State AIDS Control Society by state and district level PLHA on critical
issues. It is being implemented in nine districts in AP.
ACTIVITY 7: Improve the Capacity of Positive Networks to Monitor and Evaluate Their Programs
Positive networks have advocated for a greater role in implementing care and support programs and have
been given that responsibility in recent years. Examples include the USG-funded family counseling centers
and drop-in centers and Global Fund/NACO-funded ART peer-support services and outreach workers
schemes. However, the ability of the positive networks to monitor their own work and evaluate its impact is
minimal. MYRADA, in partnership with a positive network (potentially INP+) and with support from USG, will
implement a strategy to address this weakness. Concepts like monthly reporting, target setting,
performance-based budgeting, and formal evaluations of key intervention models will be strengthened -
especially at the state and district level - for the field-based centers to use effectively.
ACTIVITY 8: Training of Positive Network Staff and Qualified PLHAs in Strategic Information
While it is important that PLHA are involved in policy-level discussions at the national, state and district
levels, it is also important to invest in training PLHA in data collection and analysis. This will give them an
opportunity to study the epidemic from different angles and to express their opinions with the support of
evidence. Hence, MYRADA will train identified PLHA in the basic aspects of strategic information gathering
and data analyzing methods.
Table 3.3.17:
Based on a request from NACO that one agency support one district, MYRADA has agreed to withdraw
from Belgaum and Gulbarga. The four districts finalized for the MYRADA USG program, in consultation
with the Karnataka Health Promotion Trust and the Karnataka State AIDS Prevention Society, are
Chamrajnagar, Bidar, Mandya and Kodagu. All activities planned in the FY08 COP will be shifted to these
districts. In addition to the five FY08 activities, MYRADA will focus on providing technical support to a sub-
partner positive network (potentially INP+). Through this, MYRADA will provide on-site management and
technical support to District and State level PLHA networks to develop them as both advocacy and service
units.
ACTIVITY 6: Technical Support to a Positive Network (partner TBD)
A key area that MYRADA will focus on is technical support to a positive network (potentially INP+). PLHA
network organizations are independently registered groups at the state and district levels in India. These
networks receive financial support from various national and international governments and other agencies.
MYRADA will focus on training PLHA organizations affiliated to INP+, on management, monitoring and
evaluation and reporting systems. The activity will be within the states of Tamil Nadu, Karnataka and
Andhra Pradesh.
Institutional system strengthening helps PLHA groups to conceptualize innovative programs and promote
sustainability plans. It also strengthens the skills of PLHA to enhance program management. MYRADA, in
potential collaboration with INP+, will provide on-site management and technical support to District and
State level PLHA networks which will help to strengthen their information and other management systems,
including the registration and legalities required for a locally registering an organization. Staff will be trained
in at least 40 taluk and district level networks in M&E, book keeping and regular office procedures.
Providing clinical services is a part of the service delivery systems of the PLHA network.
A consultant will be hired to visit the networks and impart basic clinical knowledge to the network leaders,
who in turn will motivate members to access proper clinical services at the local services.
Additional potential collaboration between MYRADA and INP+ will focus on strengthening District Local
Networks (DLNs) as both advocacy and service units. DLNs currently receive funds under the Global Fund
for AIDS, Tuberculosis and Malaria to provide ART support services, hire outreach workers to track down
ART defaulters, assist positive pregnant women in accessing safe delivery and treatment, and establish
drop-in counseling and support centers. DLNs are also tasked to provide effective linkages between PLHAs
and care providers, including services for TB treatment. DLNS will be provided with training in human
resource management, monitoring and evaluation, and HIV care and treatment packages.
In order to improve access to HIV/AIDS prevention and care services, there is a critical need to strengthen
health systems at all levels, to introduce innovative field models that are cost effective and sustainable and
to influence policies to adopt successful models. Myrada will support the Karnataka State AIDS Prevention
Society (KSAPS) for systems strengthening, and will also strengthen the response of the local governance
to community needs for HIV prevention, care and support.
been working in the areas of empowerment for poor and vulnerable women, natural resource management,
reproductive child health (RCH) and HIV/AIDS mostly in the state of Karnataka. All Myrada's work is built on
the underlying principles of sustainability and cost effectiveness through building local people's institutions
and capacities, and fostering effective linkages and networking. These principles have been incorporated
into the Myrada CDC program, which has developed several models of effective interventions that can be
replicated and scaled up.
Myrada has developed an excellent working relationship with KSAPS. Myrada has supported various
KSAPS programs as well as implementing targeted intervention, and community mobilization programs with
KSAPS support and is a member of the KSAPS Technical Resource Group for Communications. At the
local level, Myrada has strengthened the capacity of local institutions to create long-term village structures
to facilitate follow up for behavior change communication programs and create strong linkages between
prevention, testing, and care. As a result, village health committees that work with gram panchayats (local
governance units) have been piloted in over 100 villages.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Technical Support to KSAPS
In collaboration with KSAPS and CDC, the program will focus on providing technical assistance to
strengthen the operations management and monitoring and evaluation systems of KSAPS. This will be
done at all three levels: state, district and field. Activities will include placing full-time consultants in KSAPS,
organizing capacity-building programs and developing operational guidelines. Myrada will continue to
support the IEC program component of KSAPS. At the field level, active support will be given to the local
Integrated Counseling and Testing Centers (ICTCs); at the district level Myrada will provide technical
support to the district support team and nodal office. This program will directly support at least two district
management teams in Chitradurga and Chamrajnagar districts, as models for the state to build upon.
ACTIVITY 2: Working with Rural Development and Panchayat Raj Institutions
At the village level, Myrada has worked to support the development of village health committees and
Activity Narrative: conducted trainings for gram panchayat (local sub-division organizations) members. These community
members and local leaders have agreed to support a subcommittee at the gram panchayat level dedicated
to address the health needs of their constituency including HIV/AIDS. This subcommittee would have
representation from the local health department and one or two representatives from each village. The
subcommittee will be merged with the village health committee to ensure that there are regular meetings
and that the subcommittee is accountable to the local administration. Also, linkages to social entitlements
and services will be enhanced through the direct involvement of the local administration responsible for
these areas.
Myrada will continue to engage Panchayat Raj institutions (which manage the decentralized governance
system of India) and develop their capacity to address major public health and social issues such as HIV.
Myrada will offer technical assistance in the formation and training of these institutions on HIV/AIDS. This
plan will be further discussed with Panchayat Raj institutions with regard to expanding it to all districts in the
State.
ACTIVITY 3: Supporting KSAPS in Mainstreaming
Through its active linkage with the department of Women and Child Development in the state, Myrada has
worked with KSAPS to develop a program to train representatives of the women's Self-Help Groups (SHG)
in Karnataka through a combination of a satellite-based and field-based interactive approach. Myrada will
continue to advocate for statewide expansion of mainstreaming HIV/AIDS education into SHGs, which
reach large numbers of rural women, and will provide technical assistance in how to accomplish this. Other
mainstreaming approaches will include efforts to expand the youth Red Ribbon Club (RRC) initiative (see
the AB narrative) through the Department of Higher Education and Ministry of Youth Affairs; and working
with the USAID-supported Connect project to support workplace interventions. This technical support will be
expanded to other geographical areas where Myrada works in order to encourage mainstreaming of HIV
prevention issues in other sectors such as natural resource management and rural development activities.
ACTIVITY 4: Training in Strengthening Referral Systems and Procedures.
The team strongly believes that all HIV/AIDS-related services need to be integrated into the government
health system down to the grassroots level. Therefore, technical assistance will be given to strengthen
referral and tracking systems within local government health systems as well as to develop strong networks
between the government, NGOs and community-level institutions. Technical support will be provided to all
subgrantee partners to foster this linkage.
ACTIVITY 5:Technical Support to USG Partners and Other Agencies/NGOs.
Myrada will provide USG partners and other agencies training and guidance in human resource
management, community mobilization, monitoring and evaluation, linkages and referral systems, and
resource mapping. Specific focus will be on providing such support to the NGOs funded by the Avert
Society in southern Maharashtra and the CDC-funded NGOs in AP and Jharkhand.
Continuing Activity: 14296
14296 6209.08 HHS/Centers for MYRADA 6766 3964.08 $120,000
10891 6209.07 HHS/Centers for MYRADA 5617 3964.07 $135,000
6209 6209.06 HHS/Centers for MYRADA 3964 3964.06 $135,000
Estimated amount of funding that is planned for Human Capacity Development $110,000
Table 3.3.18:
